201. The Maternal Morbidity Situation In India. P S Remesh Chandran

201

The Maternal Morbidity Situation In India

P. S. Remesh Chandran
 
Editor, Sahyadri Books & Bloom Books, Trivandrum

 Image by Mojca JJ, Pixabay. Graphics: Adobe SP.

The rich in India survive pregnancy; others are usually deaths on arrival!

The main causes for the higher maternal mortality rates in Asia, especially in India, are lack of adequate pregnancy and delivery care, lack of trained and dedicated hospital staff, lack of clean and risk-reducing delivery homes for temporary stay near one’s home, higher costs of periodical checkups, lack of access to governmental blood transfusion networks and the greed for money, negligence and dereliction of doctors and attending staff. In every survey and study report published on women and mother mortality in India we will see all these causes listed except the last one. If all the listed causes are remedied but the greed, negligence and dereliction of doctors and attending staff continue, then what use is there of corrections? In 1985 the World Health Organization was convinced that around ninety percent of these women deaths in India in hospitals could have been avoided through proper handling. After the well known hike in corruption in India, especially in the health services, what could this rate be now? 

One fifth of the world’s maternal deaths happen in India and around 94 percent of these women who die with or without babies belong to low-income families. The meaning is clear: had they had money they would have survived. On an all India basis the most women dying in association with pregnancy is in the state of Assam. In South India the most women dying is in the Karnataka State. The fewest maternal deaths are in the Southernmost and the highest literate state of Kerala- an environment created and nurtured through decades by the well-informed educated people of Kerala and the health professionals and hospital staff in the state, not by the illiterate or under-educated politicians of Kerala who cannot see beyond their noses. 

Image by Juda M. Via Pixabay.

The United Nations evaluated that as a Millennium Goal Signatory Country in the General Assembly, India could not achieve the goals in bringing down maternal deaths. It was not because of the insufficiency of budgetary provisions but because of the horrible corruption and illegal eating into in the budgetary provisions. That was the picture in 2005- one fifth of the world’s maternal deaths happening then in India. With five years, according to the 2010 international estimates, this mortality rate improved- it became one quarter of the world’s maternal deaths happening in India instead of one-fifth! Where were the constitutional bodies including the state and the national human rights commissions and women’s commissions and the various parliamentary committees during this period? Why couldn’t these apex bodies prevent at least the increase in women deaths? 

1,25,000 mothers or would-be mothers died each year in India. Still the statistics projected by the government’s health authorities internationally claimed that there was tremendous progress in curtailing mothers’ deaths in India. One was statistics, the other was reality, and the world could see through. In 2014 India’s maternal deaths reverted back to the one-fifth’s place in international estimates. Why? The international bodies, as fund givers, began to investigate and ask for details of actions taken including penal actions and compensations to victims given during the past years, following internet articles describing the atrocities against women going on in India in hospitals without anyone penalized and without anyone given compensations. There were frantic searches for old case records in hospitals before forwarding the required reports within the deadline. Every record and file ended where the incident was reported to higher authorities. Those were the last communications in those files and records. There ended action. When the reports were received and the truth of none penalized and none paid compensations for years found out, international agencies stopped funds to India health: in those countries it is a crime to finance human rights violations and corruption. Theirs is world people’s money anyway which cannot be released to unaccountable establishments. So government became unable to continue to bear the expenses of maternal deaths on behalf of doctors and the doctors began to be ordered to pay compensations to women victims from their own pockets. Incidentally the first order of the kind originated in Kerala in a case of leaving surgery scissors inside the abdominal cavity of a woman in the operation room of the Taluk Headquarters Hospital, Nedumangadu in the Trivandrum District. The order came from the Secretariate of the Government of Kerala. No wonder women deaths in India began to come down. 

If government has surplus money from foreign funds in addition to the usual budgetary provisions it will happily pay compensations to victims on behalf of its doctors. If the foreign funds dry up and the government has only its own budgetary fund it will not have enough funds to pay compensations for women from what is left after the inevitable corruption by its departments and darling officers. So it will ask doctors to pay compensations from their own pockets. So, women deaths and atrocities against them in hospitals stop. Doctors and subordinate staff become more careful. So, that is how international funds to India health finances human rights violations and corruption. That is the logic behind the argument when international funds stop, atrocities against women will also stop in Indian hospitals. 

Most of government’s convictions and beliefs on pregnant women are amateurish than mature. The fools in government- all males of course- predicted and government once believed and departments propagandized that once a pregnant woman in a household who did not go to a hospital and died in child birth at home, all other women in that household for generations to come would go to a hospital for giving birth to a child. The truth was, after learning about the death of a woman in a hospital in child delivery, not only the women in that particular household but all women in that whole village for generations to come would never dare go anywhere near a hospital, let alone for child birth. Government through its wise guys could not understand that women dying in hospitals during child birth would deter other women from going to hospitals for pregnancy care and delivery. The medical officers of the government also helped their employer in deterring women away by butchering those who came their way. 

The government’s assurance in 2016 was that all pregnant women in India would get full ante-natal care including scans, tests, tetanus injections and iron folic acid tablets for 100 days. Only the rich and only the educated and only those who could travel got them and believed to have delivered healthy babies safely. Those in rural homes with no means of travel and money never got them. It was all like hotel brochures offering luxury services with their bug-infested beds, unhygienic cheap food and blood-pressure raising services. It was estimated that in most states, only about two to three percent of women who even got to those institutions got these services. The money allotted by government was there but no services, like a river running into parched dry desert sands and totally vanishing within minutes. 

In a country where geography and ethnic composites are diverse, there will also be local factors affecting pregnancy adversely. There can be calcium-deficient areas and protein-poor areas depending on location. Inland villages can be iodine-short and sea shore villages iodine-rich. Highlands and lowlands will have different oxygen saturation and different rates of oxygen intake and breathing. All these may affect pregnancy and child delivery and contribute to the local community factors. Local health care personnel are expected to know about these local community factors and take them also into account while providing women pregnancy care. If they know about these depends on whether these staff are long-stationed there which is never possible with the frequency of transfers and postings in the health services. And these transfers and change of stations is too frequent in health services, precipitated at their whim and impulse or like or dislike of those subordinates in the field in remote stations by senseless bureaucrats sitting in city offices, to keep these local factors well known to and accountant for by the personnel who are sent there. Also know that the general norm in the Indian health services is none will be allowed to stay at a station for more than three years for fear of contracting the national diseases of corruption and graft!

 Image by ID 4935210. Via Pixabay.

We can understand people dying for unknown diseases with no known cures. But that is not the case with child birth. Child delivery has been going on in the world since the first man and woman appeared out of nowhere. Every aspect of this process is well known to man. Whatever complications arise, they have also been predicted and regimens instructed in advance. Every kind of check lists is available with the health services, accessible to doctors, nurses, technicians and para medical staff to be followed in emergencies. The only complication and unknown factor is in keeping the woman healthy in her home before and after child birth, and providing the conveyance to pick up and deliver her to the nearest hospital the earliest. That was where India failed miserably. Studies conducted in various Indian states proved that most women deaths were for want of transportation to a hospital. Even if there was it was all over before the woman reached a hospital because the transportation was not quick. Most cases were deaths-on-arrival. And most cases were tea plantation workers in the remotest places also, with the unlikeliest of communications and the scantiest of transportation. 

If you have money, if you have a mobile phone, you can call a taxi and pay the fare for going to a hospital when the delivery pains begin. Or you can only subject yourselves to whatever experienced local help is available in the village, which will usually be better than whatever is available in a hospital, i.e. with your kind of money. Often you survive with the local midwifery skill and deliver a baby and at times you give in, with or without delivering a baby. Village midwifery skills were available in plenty in villages and were more than enough to cater to the needs of the womenfolk in those villages. This pool of skill was supplemented by the Senior Midwives and the Auxiliary Nursing Midwives retired from government service. So this pool of expertise always remained there, the dying ones replaced by the retiring ones. Then the greedy medical field noted this after the overcrowding of gynecologists in the cities and no one getting anything to even break even after the cut-throat competition among doctors. Their trade organizations handsomely attired as the Indian Medical Association and the State Government Medical Officers’ Associations moved in for the kill and swayed government to harnessing the local skilled midwifery services in villages so that they could monopolize this child delivery care in villages too and a get a portion of the pie there too. 

Remember that even in government hospitals, it is skilled midwifes who make most deliveries safe and possible and prevent botched deliveries from becoming blood baths, not doctors, because these midwifes are far more experienced that those green inept doctors. And when such botched deliveries end in maternal deaths in hospitals, these organizations again move government to declare official investigations into such incidents so that the fire of public fury could be doused and the involved attending staff could be finally absolved officially in the end. And these ‘investigating officers’ will of course never be ones who experienced at least once the pain of delivering a baby but all males who caused that pain. There are hundreds of such reports on the death of women and children in hospitals in India and any one can check who those ‘specialist members’ in those committees were- males or child-delivered females. And anyone can also check what those ‘specialist investigations’ outcomes were. 

Enquiery committees on maternal morbidity constituted by culprits.

Every special committee report on women’s pregnancy deaths in hospitals in India says a few things which are standard as if no one knew about them! These ‘specialists’ reports’ till today never have specifically mentioned corruption and bribery rampant in hospitals as one of the main causes of women deaths in hospitals. These specialists, if and when they were in service, may have been the heaviest bribe-takers and the most corrupted in their services. Their reports abound in references such as ‘community-based clean and safe delivery huts must be provided to pregnant women (must be to die in isolation!), utmost care must be given to them during and after delivery (i.e. ask them to come to hospital with bribes everyday!), pregnancy care must be brought to villages (to monopolize and commercialize pregnancy care in villages too), a national blood transfusion network shall be established (this world space club member country doesn’t even have one still today!), and teach young girls health and sex (they have not yet heard of You Tube!), and every other thing that are pleasant and safe to say. But not a thing about the real threats to pregnant women in hospitals! 

It is a pleasure for detached and unrealistic officers to recommend that women coming to hospitals shall be asked by monitoring officers if they were or were not given good treatment in hospitals. After going through horrible experiences from health care staff in hospitals which woman in an illiterate under-developed country will tell investigating officers that she was subjected to unbelievable bribery and ill treatment in hospital? The only way to ensure better treatment for women is to investigate every case of bribery and ill treatment in hospitals that are rumored among people and reported in press, and punish everyone involved severely and exemplarily. But who can do this in a country where even the directors of health services are imprisoned and lying in jails for large scale corruption and bribery? 

There is also the ludicrous propagandization in these reports that maternal mortality is rather uncommon in India and therefore difficult to study. Maternal mortality is not uncommon in India, actually it is in plenty. But what is true is maternal mortality is difficult to study in India because the culprits in these cases and the ones who are duty-bound to hand over the records in these cases are one and the same. It is because even after the maternal deaths they are staying in position because they are not suspended and the records are not traced and confiscated and the investigation conducted in their absence. Since Independence, India waited sixty years to attempt an All India Study on Maternal Deaths which points to nothing but the culprits who are also the authorities making it difficult to getting available the medical records of the deceased women. 

Image by Juda M. Via Pixabay.

Regarding India, the World Health Organization and the world’s professionals have a belief that if those women are educated and rich, they will get more maternal and child health care in India. It is wrong: such women are subjected to more bribery; that is why they get that service. It indeed has to be admitted that the WHO’s are the world’s best professionals, doing laudable selfless service in the farthest regions of the world, without caring to set up their own lucrative private practices in their own large metropolitan cities and towns. But the diplomatic relations and business relations of this organization’s biggest contributors with the country concerned count and what they actually want to say does not come into their reports. Not that they do not know the real conditions of governmental health care services in India.

Images Courtesy: Pixabay.
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About the Author P. S. Remesh Chandran:

Author Profile Of P S Remesh Chandran By Sahyadri Archives.

Editor of Sahyadri Books & Bloom Books, Trivandrum. Author of several books in English and in Malayalam. And also author of Swan: The Intelligent Picture Book. Born and brought up in the beautiful village of Nanniyode in the Sahya Mountain Valley in Trivandrum, in Kerala. Father British Council trained English teacher and Mother University educated. Matriculation with distinction and Pre Degree Studies in Science with National Merit Scholarship. Discontinued Diploma studies in Electronics and entered politics. Unmarried and single.

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Post: P. S. Remesh Chandran, Editor, Sahyadri Books, Trivandrum, Padmalayam, Nanniyode, Pacha Post, Trivandrum- 695562, Kerala State, South India.
 

200. Why This Many Women Die During Pregnancy And Child Birth? P S Remesh Chandran

200

Why This Many Women Die During Pregnancy And Child Birth?

P. S. Remesh Chandran
 
Editor, Sahyadri Books & Bloom Books, Trivandrum

Image by Kevin Ramirez, Pixabay. Graphics: Adobe SP.

CROSS INFECTIONS, MEDICAL MISTAKES AND NEVER NEVER INCIDENTS TAKE THEIR LIVES

Pregnancy is a vulnerable condition with the risk of dying.

Pregnancy is a vulnerable condition in which a woman has the risk of dying. Complications may develop during pregnancy, child birth or abortion for an otherwise healthy person. Given ample treatment and care facilities exist, these complications can be cured and the woman sent away with a healthy baby. If not, both the lives of the mother and child may be lost unnecessarily. These complications arise more in poorer areas and with poorer people than urban areas with comparatively well-to-do people. 

Maternal death or maternal mortality is the death of a woman during pregnancy, after pregnancy, delivery, after delivery or during or after abortion. Maternal deaths from flu are very common and nearly ten percent of such deaths could be prevented by administering flu vaccines in time. Whether cared in clinics or outside clinics, administering anti-flu vaccines is a must for pregnant women in most cases. One fourth of all maternal deaths in the world are from sepsis, and administration of antibiotics intravenously could prevent a lot of them which unfortunately is possible only in hospital-admitted cases.

 Image by Denise Husted. Via Pixabay.

Many pregnant women die due to anesthetic errors and miscalculations which mostly happen due to anesthetists not permanently employed in a hospital but their services being called for from other hospitals on a temporary basis whose commitments may even be to their mother institutions only. Hemorrhage and loss of fluids are other common causes and neurological problems also contribute to creating untoward conditions and situations during pregnancy and child birth. Medical complications and surgical complications arising in hospitals also lead to maternal deaths in quite a number of cases. 

Going to hospital with flu and returning with all the diseases in the book.

‘Went to hospital with flue and came back with AIDS’ is something we have been hearing for a long time. Cross-infection or hospital-acquired condition in general terms and nosocomial infection in medical terms is a dread of all hospitals and medical professionals. It simply means a person going to clinical settings like hospitals, clinics, nursing homes and laboratories returns home with an infection, the infection having been originated from the clinic’s environment, equipment, staff or other patients, transmitted to our woman through direct or indirect contact, air droplets or airborne vectors.

Image by Sanjasy. Via Pixabay.

Most people forget that a pregnant woman has to breathe, eat and drink for two people. And her body weight will be higher even while her muscles and bones remain only as strong as before. Naturally her guards will be low against acquiring infections in hospitals. She may return with new groups of bacterial and viral colonies in her inside or outside like Acinetobacter baumannii, Candida albicans, Chaga’s disease, Clostridium difficile, Enterococcus, Escherichia coli, Legionnaires' disease, Pseudomonas aeruginosa, Staphylococcus aureus, Stenotrophomonas maltophilia, Tuberculosis, or anything microbial the like. She may have contracted blood infection, gastroenteritis, pneumonia, puerperal fever or urinary tract infection while at hospital.

 Image by Luliia Bondarenko. Via Pixabay.

The staff may have been careless and may have compromised sanitation as lain down in books and kept rooms, equipments and uniforms not sterile. They may not have subjected the rooms, equipments and their uniforms to enough chemicals, steam, heat or ionization, covering in and out and all surfaces. There may not have been used hydrogen peroxide vapor or non-flammable alcohol vapor for disinfection and surface sanitation, or ultraviolet cleaning may not have been available in that hospital for disinfecting microbial organisms which are prone to living and growing on non-living surfaces like furniture, wall fixtures, switches, knobs, buzzers, window and door openers and even protective guard rails of staircases etc., and etc., for any length of time. Their patient isolation system may not have been effective and strictly in adherence to protocols.

  Image by Samuel Lee. Via Pixabay.

Not washing the hands brings so many diseases.

Image by Dimitri Houtteman. Via Pixabay.

And even the patient in her weakness may have forgotten or even been reluctant to wash her hands regularly and keep herself away from sneezers and talkers. We know a number of kinds of bacterium and microorganisms are temporary or permanent residents on the human hands, human skin. Some are protective and since man has learned to live with them for ages they have become friendly and even mutually benefiting. By their presence they prevent other hostile and unfamiliar organisms from colonizing our hands and bodies, like our dog present in our compound prevents other dogs from entering our compound. These resident in-house bacteria are less pathogenic and have a very low infection rate. They are the Resident Flora of the outer layers of the surface of our skin and generally do not transmit from hospital staff’s hands to patients as they are already present in the patients’ skin surfaces too. Like the white blood corpuscles in blood they have through eons evolved as a second defensive column on the outside of the body with time. But another kind of bacterium and microorganisms colonize human hands and skin, jumping and propelling themselves to there from the environment, especially the hospital environment, and live and grow there temporarily, and they are pathogenic and have high infection rates. They are the Transient Flora of our skin. It is to get rid of these second type of invaders that the hospital staff’s as well as the patients’ hands are advised to be washed with antiseptic soaps, alcohol gels, alcohol rubs, sanitizing gels, sanitizing wipes or whatever it is prescribed and available in that hospital to prevent contamination and infection of the patient from direct contact and by touching contaminated surfaces. 

Image by Sharon McCutcheon. Via Unsplash.

Hospital staff maintaining correct hand hygiene alone would reduce nosocomial infections by forty percent. Patients also keeping correct hand hygiene would reduce it by another forty percent as they transmitting them from part of their body like ear or neck to another part of their body like eyes or nose by touching is too natural and too common to be avoided. As so many visitors come to hospitals and they cannot in most cases keep back from touching and even kissing and stroking their loved ones lying there on the hospital beds, the rest twenty percent is unforeseen and unavoidable in the present circumstances in clinical settings unless full health education is possible for the whole human population. We can guess how many skin microorganisms would be there in the gold ornaments and watches the staff wear in spite of regulations on wearing them while on duty- a regulation the most disobeyed in hospitals. Some of them, even though they wear the mandatory hand gloves and masks, do not change them after one patient, increasing the possibility for yet another infection. This non-changing of hand gloves and masks after attending to one infected patient is also the reason why many equipments in use get infected too. 

These attending staff including doctors, nurses and orderlies may not have washed their hands in alcohol rubs before and after each patient contact. Even in Intensive Care Units the percentage of doctors adhering to hand hygiene compliance mandates are as low as twenty percent to as high as only eighty five percent. It is never and nowhere a hundred percent. The same is the case with wearing gloves and masks. Or these staff may even have been careless in handling antibiotics and other antimicrobial agents in the hospital, adding risk to the patient. 

Pregnant women surrounded by a microbial world of infections.

In America alone, around one hundred thousand people die each year from nosocomial infections and around two million get afflicted with them in hospitals. In England their numbers are only increasing. The mortality from nosocomial infections is better in Europe with 9000 dying in France, 7000 in Italy and 3000 in Belgium annually. Switzerland and Finland fare better than these three. Most of these are pregnant women dying and get afflicted as they are the most susceptible to nosocomial infections due to a number of conditions. In studies on labor room infections it was even proved that ‘medical student trainees were causing more infections than midwifery trainees’ as they were coming directly to the labor rooms from practical classes with cadavers. 

Image by Tim Kraaijvanger. Via Pixabay.

Catheters are one prime source for infections acquired in hospitals. To make them infection-free some hospitals use ethanol introduced into the catheter which has more possibility of causing harm through ethanol reaching the patient’s blood stream in incompetents’ hands. Over-prescription of antibiotic drugs for patients can cause antibiotic-resistant strains of bacteria to evolve. No effective drugs are available for a few of these infections and a few among these declare themselves to be drug-resistant. No known antibiotics are of any use in fighting them. And their antibiotic resistance is growing. Some of these infections may have to be neutralized through ultraviolet irradiation which creates other new problems. 

Image by Tania Dimas. Via Pixabay.

We have heard about the drug company which manufactured the mother-of-all vaccines which eliminated every bacteria and virus in the human body. It eliminated even the useful bacteria present in intestines making digestion and assimilation possible. Millenniums of man-bacteria balance of mutual friendship, familiarity, usefulness and coexistence which the human body was accustomed to since its evolution from the primeval form was toppled. The equilibrium of existence was tilted in favour of bacteria. Cancer vanished the moment this drug was administered but the patient died soon after from the invading armies of new and unfamiliar and hostile bacteria colonizing and thoroughly defeating the human body in the absence of the long-familiar friendly ones!

 
Would-be mothers over-prescribed and over-medicated.
  Image by Scozzy Lee. Via Pixabay.

During pregnancy not a few women who otherwise are healthy are compelled to take over-medication prompted by doctors who are unsure of even themselves. Many of these doctors receive gifts (not just refrigerators or air-conditioners but cars, villas and foreign holiday flight and stay tickets) from drug companies for over-prescribing. Maternal deaths from overmedication are a more acute problem now, indicating the undue influence of drug companies over young doctors as well as veterans who all benefit from over-prescription along with those drug companies. Most of the health care professional in hospitals and those outside are put under enormous pressure to prescribe drugs and medicines wherever and whenever they can so that compliments could be unloaded to their premises by companies as part of their aggressive marketing. Proper diagnosing will leave a paper trail of crime as record behind and would prevent over-prescription. So they over-prescribe without proper diagnosing! All are pleased in this business at the risk of the patient being put to complications and harm and even death. Pregnant women and children are the most vulnerable and submissive to the treacheries of the unscrupulous trade practices of this patient care industry. 

Medical errors cost the world an additional expense of 3000 billion dollars every year.

10 to 15 percent of all deaths in the world are caused by medical errors. More deaths are caused by cancer and heart diseases only. So, of all deaths in the world deaths from medical errors caused by health professionals ranks the third. And their numbers are also increasing at fearsome rates. No threat from authorities or occasional exposures by press has been able to curtail the growth in their numbers. Why it is so is because due to trade unionism, no professionals involved in medical errors ending in patient deaths could be brought to justice or dismissed from service. Let off with light warnings or even lucky to have the incidents suppressed from public notice, they continue to commit medical errors in hospitals and kill patients. It is pregnant women’s safety that is the most affected in these cases as they are the weakest and the most helpless among patients. Even more than half among them do not receive the mandatory care anywhere in the world if they do not have money. The negligence shown towards these grave offences even by the world health care organizations and their eagerness to protect their own hides is reflected well in the International Classification of Diseases having no codes for human errors. 

We have heard the adage ‘never go to an old lawyer or a young doctor’; the first will have lost steam for winning cases and the second will not have enough experience for not making medical mistakes. Young lawyers are the ones who win the most number of cases and old doctors are the ones who commit the least number of medical mistakes. Human errors lead to the lion’s share of medical mistakes and system errors lead to the rest. Age and inexperience are determinants in the increase of medical mistakes. That is why the old doctor is preferable as a rule. Unfamiliarity with new medical procedures and carelessness in entering medical notations for the subordinates to read and act upon also add to this. Avoidance of market names and adhering to generic names in prescriptions was intended to bring down medical mistakes but it seems it did not. 

Medical error is a term used in health care to cover up from as little mistakes as extracting the wrong teeth to as grave mistakes as administering wrong anesthetics in wrong dozes resulting in homicide. Preventable medical errors are a staggering One million in America each year and Eight hundred and Fifty thousand in England. These cause billions of dollars and pounds of additional expenses and around Two hundred thousand preventable deaths around the globe every year! How many among these hapless human beings are pregnant women and children? No accurate numbers are available with anyone. Sure, no one on the clinical or administrative side agrees alike to using the words ‘preventable’ and ‘avoidable’ in connection with people’s deaths in hospitals but they are deaths indeed, happened inside hospital walls. In their frantic move to vindicate themselves a part of the American Medical Association in 2011 even went to claim that only one out of ten thousand of such hospital deaths would be preventable!

 Image by Julita. Via Pixabay.

Most medical errors are medication errors. While reading x-rays and other medical images, thirty percent features in them- plainly visible or cryptic- are usually missed or poorly interpreted, which also lead to medical errors. Not only pregnant women and their babies but other patients also die in millions each year in hospitals due to surgical and medical mistakes hushed up by authorities. And medical errors are expensive too. When medical errors occur, the affected patients will need to be provided additional medical services. It will double the expense because the earlier medical condition of the patient before the medical error occurred is still remaining to be treated. So the world is burdened with an additional expense of around 3000 billion dollars on account of medical errors which could have been prevented from happening with a little care and diligence. The expenses which will have to be borne by the hospitals on account of these medical mistakes may even ruin those institutions financially, besides them sure losing their good names.

 Image by Chuck Underwood. Via Pixabay.

Employee dissatisfaction is one major cause of medical errors.

Employee satisfaction is an important factor in ensuring patient safety in hospitals. It is when a professional is very weak and tired in mind and body that he or she is prone to making mistakes. Dearth of staff leads to professionals working twenty four to thirty six hours continuously in many hospitals, limiting their rest to intermittent ones in the call duty rooms between when their names are announced in the public address system. In such miserable conditions of hospital duty we cannot expect them to be always alert and function as well as when they are rested, washed and well fed. And the stress from their family problems arising from these unpredictable and ungodly hours of duty also adds to medical errors. The divorce rate among couples where one or the other is not a doctor is high. Burdened with loneliness, child support and alimony, not a few falter in the medical steps they take though they taking their own lives is rare; they take patients’ lives instead. 

Have anyone tasted coffee from those vending machines in hospitals? Even a cup of decent coffee would not be available to them during their strenuous duty hours. Some good doctors, especially women, will have thought about retraining themselves and joining as nurses so that they could care for human beings without the responsibility for decision-taking. If one mistake happens due to their tiredness, there will be no one there to share their responsibility. The hospital administrators and the management who were primarily responsible for the overworking of doctors and their overall tiredness leading them to making mistakes will wash their hands and turn their backs at the very mention of a hospital mistake. 

Even vigilant doctors cannot override electronic systems if needed.

In hospitals where they have automated a major part of patient care and treatment, the attending physicians and nurses won’t be able to read the full patient data in their monitors but only fragmented information due to a number of factors including computer glitches, technicians’ laxity in updating data and system failures or even their accessibility restrictions, and as there will be no conventional charts at the foot of the patients’ beds to read, they can make use of only this fragmented information to make decisions which may or may not lead to medical mistakes. In that event, they cannot defend themselves by saying that they were not responsible but it was the fragmentation of the information that led to the mistake. If they point fingers at the hospital’s automated system which the hospital management proudly boasts about in public relations, they will be dismissed with adverse remarks in their reports. Moreover, a vigilant doctor, if he or she ever detects a data error in the system, cannot override the system if needed. He cannot go beyond the set parameters and can do only what the systems says to do. (That is how the major chains of hospitals operate without engaging competent and highly-paid doctors in staff: they do not need them as the system can do the diagnostic and prescriptive things they are expected to do. Know that most of these systems refine themselves with each case, artificial intelligence helping not less). 

In automated systems like these it is expected that who takes what action on which patient where at a given time is entered into the system in real time and all data will be available to all concerned to read but it happens only in code books, the result being no one takes any action on the patient at that given time. In reality most data unless it is meant for the billing department are entered only at a later date, usually after the patient is dead or discharged, most often only when it is noted by an administrator that a conspicuous backlog is there. This happens at institutions with only a rudimentary system and not (always) in hospitals which are part of world chain hospital systems. In those hospitals the doctors are not a significant part of the treatment anyway. The main drawback here is they are too reluctant to handover information on previous treatment of patients who are now admitted in hospitals outside their chain, for fear of exposure of their own mistakes. 

Doctors’ pride prevents them from learning from subordinates and leads to medical mistakes.

Layers of protection are usually there for protecting patients from medical errors. If an attending physician or a nurse makes a mistake on medication, another staff in the pharmacy may pick it up immediately while dispensing those medicines and get it corrected. Or even the unit chief may pick it up. But if and where most of the staff is negligent, careless, sluggish and lazy, there is no safety for the patient.

 Image by ID 947051. Via Pixabay.

In most cases the pharmacists would know more about the adverse effects of some drugs on some patients. But most physicians will be unwilling to working in tandem with pharmacists in their hospitals, for reasons of unreasonable pride and self respect. The pharmacists too are experts in their field, and often more current in their knowledge of drugs notified with harmful effects the latest and their best available and safe substitutes to administer because they are not burdened with as tight a work schedule as physicians in a hospital and are probably getting more time to read and update themselves than doctors. Just by asking, their vast information on medication safety would have been available to doctors to select drugs and medicines between, but they do not ask. 

Health departments have a system of circulating periodical reports of drugs slow-moving in various hospitals- a system by which a drug which is slow-moving in a hospital could be called for by another institution where it is very much needed but not in stock. In any hospital the pharmacists would be the first to know about these things, not doctors. They would also be the first to know about which drugs or which batches of drugs by which manufacturers have been called back from circulation and for what reasons. Though in the lower rung of hospital hierarchy after doctors and nurses, the pharmacists are the first to depend on to ensure medication safety. 

Admitting medical mistakes to patients is better than covering up.

Cover-up of medical mistakes is not advisable under any circumstances even where such mistakes will not harm the patient much. A physician himself explaining to a patient a medical error soon after it has been committed is the best practice to be followed and the most advisable thing ever. The patient’s anxiety is considerably reduced once he learns what actually has happened to him. Even if it is an unrectifiable mistake, the knowledge of what has happened is a consolation in itself, or else he cannot associate the resultant problems with anything at all. Once told of the mistake he can relate the associated problems to that mistake. Though it is a shame for that physician in particular and that hospital in general to make a full admission of a medical mistake to a patient or his relatives, the truthfulness of the admission will not go unnoticed and will be beneficial to the system in the long run, though it will destroy the patient’s confidence in the system for a time. We cannot totally condemn a truthful man. 

It is in mankind’s nature to forgive, though not to forget. Once explained to a patient why and how the medical error had happened, there is more chance of his forgiving, because it would not be the first time that he went to a hospital, got cured and sent away. He certainly will have to say a few good things about doctors, nurses, orderlies, cleaning staff in particular and hospitals in general from his past experiences. But is also strange to note that it is also in human nature when one gets healed, gets home and regains health and strength and resumes life as normal as it had been earlier to not remember that he had been in a hospital for several days, had been in a very critical condition and it was with the help of so many unknown people that he was brought back to life and health and comfort. But some good memories do linger and tend man to forgive. A word of apology from the responsible person would be enough. 

Seventy percent of doctors look down on medical mistakes committed by their colleagues as heinous lowly crimes and respond unsympathetically to those doctors exposed thus, even while an equal percentage among them will remain indisposed to revealing their medical errors to their patients where those medical errors were committed by them. They do not even like using such words as ‘medical error’ and ‘admission of truth’ for that matter. So there is no use in seeking support of colleagues when medical mistakes occur. It is even better to admit these mistakes to the patients or the patients’ relatives. This admission or confession does not necessarily mean it will be invariably followed by a prosecution or a claim for compensation always. Many countries and many states in many countries have legislated making one’s own such voluntary confessions not admissible in court for prosecution. In fact, non-admission of the medical mistake would often be admissible as evidence in such cases. 

The biggest killer element: the world of hushed up Never-Never-Incidents.
 Image by Luis Silva. Via Pixabay.

Thousands of pregnant women die each year from Never-Never-Incidents which are hushed up in hospitals by authorities. These are incidents in the medical field that never should have happened- serious events which could have been prevented from happening which are becoming a great concern for mankind. They are termed ‘Never-Never-Incidents’- in common use Never Incidents or Never Events. They primarily occur from medical mistakes committed by medical professionals. There are medical mistakes as well as surgical mistakes. Suppose a surgeon looking at an x-ray film posted on a lighted wall in the operation theater operates on a kidney. He removes the wrong kidney without knowing that the x-ray film was posted there in reverse. So instead of living with one good kidney the patient will have to live for a few more months with one bad kidney- the good one having been removed-, undergoing costly dialysis everyday. Neither the doctor nor the hospital administrator will reveal this to anyone. They will not admit to anyone that a mistake had been committed. There will be a cover-up, a blanket put on the incident. The patient will not be told. So this is a surgical mistake- a Never Incident, a Never Event. There are also dozens of kinds of similar medical Never Events happening daily. 

Operating on the wrong body part, doing the wrong operation on the body and operating on the wrong body are all never events. Malfunction of medical devices, contaminated drugs and medicines- all cause them. Leaving foreign bodies like scissors and cotton mop in patient’s body cavity after surgery is completed and the opening is sutured is very common. Wrong drug and wrong dozes cause them. Allergic and hemolytic reactions are common due to not conducting prior checks on the patient. Pregnant women die in scores each week due to carelessness in labor room care. Electrical systems and air vent systems may malfunction and microbes supposed to be kept out may come in unexpectedly without saying hello and spread throughout the theatre, wards and the entire hospital. Instead of oxygen other gases from other sources may come into ventilators and make patients dead or brain dead- making them vegetables for ever, requiring continuous life support till they are plugged out. Simple deliveries may become botched surgeries and bloodbaths. Wrong chemicals may be flowing through the intravenous lines. Even inept junior residents may misread senior doctors’ notations in medical records such as asap. and stat. and do funny deadly things on patients, needing them to be removed to freezers finally. (ASAP is acronym for As Soon As Possible and stat. is short for statim, meaning immediately). As the number of incompetent doctors increases, the number of Never-Never-Incidents also increases worldwide. 

The numbers of Never Events are not small. Throughout the world there will be millions of such Never Events every year. Because of the cover-ups only a few persons will know about them and still fewer incidents will come out. Most of them will not even be reported to anyone or recorded anywhere. Because huge compensations will have to be paid, this cover ups will be very efficient and total. No medical ethics are pertinent or practiced here. If revealed, these incidents can cause many famous hospitals go under. In America in 2012 alone the numbers of medical mistakes were 1500 and surgical mistakes 4000- reported. Probably below one percent on what actually happened! And they say the Unites States is a developed country with a far advanced medical science!! 

Following the hush-hush news of Never-Never-Incidents increasing in hospitals at unprecedented rates, the confidential investigation committees in America and England recommended four commendable actions to be taken following the occurrence of each Never Event in a hospital, namely, ‘apologize to the patient, report the incident, perform a root-cause analysis and waive costs directly related to the event borne by the patient’. But apologizing to the patient will make him or her know of the incident and file suit for damages, reporting the incident will result in the immediate dismissal of that doctor or nurse from service, performing root-cause analyses will bring to daylight all similar incidents happened in that hospital in the past and disgrace that hospital in the public’s eye, and waiving all costs borne by the patient directly related to the incident will again let the patient know of the incident when he gets the bill. So suppression and cover-ups of these incidents continued and these committees got only below one percent of all such cases reported in records, which still proved that there were ‘172 wrong body parts operated on and 97 foreign bodies left in patient’s bodies in ten months in England alone’! Imagine the number of Never Events going on in Asian countries including India each year!!

 Image by ID 5540867. Via Pixabay.

Images Courtesy: Pixabay.
Written and first published on:

FROM THE BOOK:

https://www.amazon.com/dp/B087D34RVM 

Tags:


English Essays Articles, 

About the Author P. S. Remesh Chandran:

00. Author Profile Of P S Remesh Chandran By Sahyadri Archives.

Editor of Sahyadri Books & Bloom Books, Trivandrum. Author of several books in English and in Malayalam. And also author of Swan: The Intelligent Picture Book. Born and brought up in the beautiful village of Nanniyode in the Sahya Mountain Valley in Trivandrum, in Kerala. Father British Council trained English teacher and Mother University educated. Matriculation with distinction and Pre Degree Studies in Science with National Merit Scholarship. Discontinued Diploma studies in Electronics and entered politics. Unmarried and single.

Face Book: https://www.facebook.com/psremeshchandra.trivandrum
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Post: P. S. Remesh Chandran, Editor, Sahyadri Books, Trivandrum, Padmalayam, Nanniyode, Pacha Post, Trivandrum- 695562, Kerala State, South India.

199 Introduction to: Are Our Women And Children Safe In Our Hospitals? P S Remesh Chandran

199

Introduction to: Are Our Women And Children Safe In Our Hospitals?

P. S. Remesh Chandran
 
Editor, Sahyadri Books & Bloom Books, Trivandrum

Image by ID 3151634, Pixabay. Graphics: Adobe SP.
 
1

Deaths from adverse effects of medical treatment are increasing in the world, not decreasing. Now it is between 2,25,000 and 1,50,000 people dying every year this way. Three-fourths of these are from harmful drugs’ administration and one-eleventh of all from unnecessary surgeries conducted. Medication errors cause fewer deaths in hospitals compared to those from harmful drugs and unnecessary surgeries. An unbelievably great number among these dying are pregnant women and also unborn children who die with them. 

When medical technology advanced, it was expected that the death of people from medical diagnosis and treatment errors will decrease. It did not. The twenty five years from 1990 to 2015 witnessed tremendous growth in medical advancement but during this period the number of deaths from medical diagnosis and treatment errors also increased by roughly forty five percent! Then what is medical advancement and where is it? 

The hospital staff responsible for maternal deaths are primarily doctors and nurses, and secondarily paramedical staff like technicians, and lastly but over everyone else in responsibility the administrators of hospitals and other treatment facilities. Doctors are a good lot generally, interested only in saving lives. A few among them are but corrupt, greedy and incompetent for various reasons. The nurses are a totally devoted and caring lot except a few rotten apples among them, and such bad nurses are usually only a five among a hundred. The technicians are mostly learned and always overworked; only a very few among them are prone to making mistakes from ignorance, perhaps more from negligence. That is the picture at least in Kerala- the state with the highest literacy in India. Kerala’s doctors, nurses and medical technicians are sought after and much admired in many countries. 

A word about them: The doctors, nurses and medical technicians of Kerala are the best in the world. The parts concerning them in this book are not intended to disparage them in anyway. This author himself has witnessed their selfless services and personal sacrifices on not a few occasions while working with them. Their love, kindness, caring and dedication have been acclaimed by people in all countries where they served and lived. Dispensers of virtues, they soothe, solace and heal people across the globe. Their virtues will be sung by the people there. Pardon me; but here it is the vices in the health sector of their native land that is sung here. Someday, you will understand why. 

Along with treatment failures and errors and patient deaths, poverty caused by medical expenses often called as Iatrogenic Poverty is also increasing worldwide. It is roughly estimated that 1,00,000 families are reduced to poverty every year in the world due to heavy medical expenses. Debt, bankruptcy, attachment of incomes, confiscation of properties, eviction, impoverishment, and death- it is in that order that people perish of iatrogenic poverty. Health insurance coverage in developed countries is a joke. Health insurance in other countries is for namesake. The only desirable option is the Free Hospital System of India which even India is winding up under pressure from huge insurance corporations over the country’s top-most parliamentarians and politicians. In fact they own them or sit on their boards, like they do with petroleum corporations and keep oil prices soaring even when the world crude oil prices dropped below zero. 

2

The introductory article in this book describes a few incidents of maternal deaths due to pure medical negligence which ended as homicides. It contains true stories from India, illustrating how unsafe the lives of our women and children are in our hospitals and how uncaring and incapable of taking any remedial or recriminatory actions at all are the submissive governments in crimes committed by the blue-collared and the gowned in India. The second part explores why and how women deaths happen too frequently and too widespread not only in Asian countries like India but in Europe, America and England as well to be ignored. The third part is an attempt to examine how India fares in this worldwide situation. The fourth part assays how these governmental crimes against women and born and unborn children could be prevented from happening. 

The first part was ignited by several incidents the author witnessed or heard about while working as an employee in the government’s health department’s various offices and hospitals in Trivandrum district in Kerala, including the Directorate of Health Services, the State Health and Family Welfare Training Centre, a State Nodal Institution for Mental Health Care, a sub-district level Headquarters Hospitals and two Rural Hospitals in ministerial capacity for thirty two years. The other parts were written from memory on things learned during these incidents or after these incidents during service, or from general knowledge accumulated through years from reading, written actually after leaving service. 

Hospitals are more virtuous places than being bad places. A few years back when this author was working in the office of a headquarters hospital, happened to note the virtues of a very good pediatrician who also was a Senior Civil Surgeon and the Medical Superintendent-in-Charge there. He was a very tall man with a very kindly face and gentle speech. Children were taken to his office room by mothers when he had completed his rounds in wards. He never insisted that they should be shown to him only during rounds or in the Out Patient Wing of the hospital. They could be shown to him practically anywhere. Wherever he was was his consulting room, including the roads and other buildings in the hospital’s compound. Most children were taken to him shrieking loudly without stop and gasping for breath. Don’t know what wonder it was but the babies stopped crying the moment they neared him or entered his room and looked at his face! Once, this author noted that he was prescribing strong medicines for little children. 

Asked him why, knowing well that he must have some good reason. He told this author: “Remesh, they are brought to us in very painful conditions- conditions painful and unbearable to them. They are laboring very hard even to cry, even to breathe. Our first duty is to give them relief. With strong medicine, there will be immediate relief and then the body system and nature will take over. The body system and nature have everything to assist in treating and comforting a relieved child. We sure can give them light medicine in small dozes for several days but we will also be delaying relief also for days, and we will be keeping them in perpetual distress for many days which is not helpful. They have only a tiny body and cannot go on suffering through so many days. Moreover, as long as we give the child early relief, we will also be prompting the body system and nature to take over early.” This author was convinced. So, the immediate duty of a doctor is to give relief, not cure. 

In that hospital, at one time there were quite a number of gynecologists. At one time, of the twenty two doctors posted there, seven were gynecologists. They themselves knew there were not that many pregnant women attending the hospital for them all but they arranged their transfers to this station through influence, looking just at the lucrative private gynecology practice the headquarters town would bring eventually. Whoever joined new was a gynecologist and there were not enough doctors in the other specialties. The other specialties became understaffed. It became a problem there because there was not that number of pregnant women coming to the hospital and there were also a great number of patients needing care in the other specialties. This benign Superintendent asked this author what could be done and was told he could sent a letter secretly to higher authorities describing the situation as ‘overcrowding of specialists in gynecology and dearth of doctors in other specialties’. A letter was handwritten for him so that even the typist would not know which he signed and sent by special messenger to the District Medical Officer of Health. All but two gynecologists were transferred out immediately and doctors in general medicine posted in their place. One of the transferred out later became the DMO and eventually the Director of Health Services and you can guess how eager she would have been to hunt the perpetrator of this letter. She never stopped. Incidentally she was also the character in the incident of patient homicide described in the first article. She excused the superintendent who signed and sent it but not the clerk who wrote it. As a doctor he had immunity from other doctors. They are a privileged lot who consider themselves above everyone else and beyond reproof- the god players! 

3

Post Partum Surgery or PPS is a simple medical procedure for permanent birth control in a woman in which the surgeon seals or removes the fallopian tubules just after delivery to prevent pregnancy. As it is a simple procedure with minimal risk, the Government of India promoted it by offering remuneration to women who underwent this surgery. There were even PPS Festivals or Melas organized, with the inevitable uncleanliness and unhygienity accompanied and took away so many lives like those Government Eye Cataract Carnivals organized in open stadiums which left so many infected and blind. When this author was working as a clerk at the Taluk Headquarters Hospital, Nedumangadu, this amount of remuneration for women undergoing PPS was Rs. 145/- for the delivered woman and Rs. 155/- for the attending team to be divided among the surgeon, anesthetist, nurse, nursing assistant and hospital attendant. The surgeon was a very good one, his name actually a synonym of god but greedy. He even got an award for conducting the most number of PPS operations in the district, or was it in the state? As it was only a rural headquarters hospital there were not that number of delivered women for him to cut. It was believed that he cut a lot of women without informed consent from them or their relatives! On the second day of delivery any fool of a husband and the only accompanying male from the village will sign any paper waved before him by an authority. 

Women came to office the day after delivery to accept this remuneration of a meager amount. As the office was a little distant from the maternity wards and the women had to walk a distance in the sun and stand a little time before signing the register, there were awkward moments. There were also a number of cases of bleeding. The author suggested why not the office go to the maternity ward and disburse the amounts. That job fell on him though he objected that since he was unmarried and single he couldn’t go. Anyway the job fell on him. Everywhere there were women in various stages of undress and awkwardness and after a week the sympathetic army-served medical officer-in-charge assigned the job to a female nursing assistant. It was a new world there in the maternity ward, where everywhere there were new comers to this planet. I was proud of these little citizens and those mothers and sisters who brought them to this world. And most of the women had undergone the PPS operation too to prevent still more little angels coming to this planet. But a few of these surgeries became botched up surgeries too women deaths, mostly double deaths, with the child also dying with them eventually. One such case from this hospital is included in the first article in this book along with other incidents from other states. (A more elaborate study on such cases which resulted in international agencies stopping the foreign funds of Kerala Health Services is included in this author’s book ‘WHO IMF IBRD and ADB Money to India Health Finances Human Rights Violations and Corruption’). 

4

Once when this author was working at the office of the Mental Health Centre, Trivandrum which was also the nodal centre for the two other major mental health centres at Trichur and Calicut in the state, he was won’t to go to the outside and drink tea from a roadside plank tea shop. One very old woman was once standing there drinking tea and talking to the lady owner of the shop. From her language she evidently belonged to Trichur. The author asked her if she was getting good care at the hospital. She told she had accompanied her son to the hospital who was an inpatient under treatment there. Asked how good the hospital was and how she felt about it, she replied: ‘Son, this hospital is god; if it is not here where would I have taken my son to?’ So, a hospital is a god to these people. The author had heard doctors being described as gods but not a hospital. If a hospital is that good and a god to people, then it must be an abode of healing artists, not quarters of semi-qualified quacks. 

This particular institution was started in the past as a treatment facility for communicable diseases and insanity by the Maharajah of Travancore, primarily to house and treat those in the royal household who had contracted these diseases, by housing them at a place not too far from the palace for these inmates to feel they were too far removed from their home. That is why it was situated very near to the palace, still is. Then it became a Government Mental Hospital after the amalgamation of the Travancore-Cochin States as the State of Kerala after the Indian independence. Then decades after, as mental treatment centres had become to have more mental health care than mental disease care to provide and also to avoid the term ‘mental’, it was renamed as Mental Health Centre. The arch of the board at the entrance records this institution as having started in 1870 A.D. in the English Era and 1046 M. E. in the Malayalam Era. These dates do not exactly correspond (as it shall not if it is a mental institution!). The corresponding Malayalam Era is 1045. Standing there, drinking tea with that poor mother on the roadside, the author looked at that ages-old name board and renamed the institution in his mind: His Holiness the Government Mental Heath Centre, Trivandrum, or even, to be exact, Her Holiness, the Government Mental Heath Centre, Trivandrum! Then isn’t it necessary to uproot and remove those few unholy presences from these sanctities? It is eventually to be noted that this institution completes 150 years of service in 2020. 

This institution has its moments of glory and its lofty achievements. Of the Seven hundred plus inmates at a given time, more than half would be women. There will be a number of young girls among them. A dissatisfied and aggrieved young girl in North India or in a North Eastern Border State jumps into a train and arrives in Trivandrum Central or any other train stations in Kerala. She will wander through the roads for a few days or for even months without food and bath and a place to sleep. The wicked fellows would have abused her sexually. Without paternal and maternal care she would have been thinned and look a wretched human being. The caring people in that neighborhood would report to police. They will pick her, take her to a judicial magistrate and finally bring her to this institution by Police as a judicial admission. No name would be known or her origins. She will be washed, cleaned, combed, dressed in clean donation clothes, fed, examined, wounds attended to slept will with medication. Within months she will become a beauty and begin to speak about names, places, education. Language experts will come and begin interviewing. Her village, town, parents will be traced and informed through judicial authorities. Then accompanied by two or three women nursing staff she will be taken by train to her home, handed over to parents in police presence under judicial order. So the pet has gone home and the staff will weep for a few days at her remembrance. There will be newspaper reports, of course without revealing the real name. Scores of young girls were recovered and rehabilitated this way, all associated travel expenses being borne by the Hospital development Committee headed by the District Collector, not by the government. 

Then government posted a new superintendent to this institution who not a psychiatrist but a non-practicing general medicine man. This petty little human being observed that the connected expenses of transportation and rehabilitation were ‘unproductive’ which could be ‘productively’ used for cultivating vegetables for patients’ diet ‘relieving’ government. So this accompanying and rehabilitating recovered girls to their states stopped and the vegetable cultivation lasted till the next drought. Now these recovered girls are known to be transported through police. No one knows what happen to them on the way or if they even reach their homes. 

And this great institution has had it moments of disgrace and public shame too. The unnatural deaths of Sona and Geetha were two women death cases which have not still been explained logically. Geetha was a Trivandrum native and Sona was from outside the state. Another woman ‘mysteriously took her own life by hanging from her iron bed, sitting dead on the floor’. A Tamil Nadu woman- let us call her Tapasi- who was a bystander to a patient was allegedly raped by staff and the case ended in law court. Unable to handle the language of Kerala and persecuted and harassed by the whole trial system, and above everything else burdened with the heavy expenses of traveling to Kerala from Tamil Nadu for the trial this poor woman finally told the court she was not proceeding with the case. One morning dozens of women did not wake up in a female ward and the news spread and hordes of newspapermen and TV Cameramen flocked to the institution. Authorities arrived by express transport and a great enquiry was conducted by the vigilance wing of the health department. These female inmates were found to be ‘over-sedated from medicine’ which discovery and phrase pleased everyone- authorities and the press alike. One was nurse was removed. The fact was, these patients usually threw the medicines out through the windows into the nearby woods or just flushed them out after the ward nurse who distributed them had withdrawn. That particular day this particular nurse watched over and ensured that they all took their medicine which was diazepam mainly. Hence they were not waking up the next morning. It was not ‘over-medication’ as the authorities phrased it but it was the first time they were taking any kind of medication for a long time! 

Today, in institutions such as these, patient suicides and murders continue- unquestioned, un-prevented, uninvestigated. Public works department officers, works contractors and top-level bureaucrats in government make millions out of these institutions by way of ballooned up work estimates, bogus bills and no-sooner-it’s-completed-than-it-leaks works. Today this particular institution is a tourist paradise- anyone can go in there with a camera or a mobile phone and shoot and photograph- a naked violation of international patient privacy rights. No administration, no monitoring, no control because psychiatrists are not the administrators there now, after the government introducing Specialty Cadre for doctors under which any pen-pusher who has not had any patient contact for years can opt Specialty Cadre and become Superintendents in any specialty hospital in Kerala even without the mandatory recertification every five years. The health minister of Kerala tells press that she is the world’s foremost health minister and her department is the world’s best. And the press which is vigilant everywhere in the world bites it hook, stinker and line. Who is mad- those inside or those outside? Those inside who are mentally ill cannot speak coherently anyway. 

5

Even before joining the health services department of Kerala as an employee, this author had been a frequent visitor to a medical students’ lodge and hostel during college days. That was when he learned about the various methods of ragging going on in medical schools with the objective of subjugating younger students and how pseudo doctors could go to seashore villages and rural inland hamlets and set up practice. Some pass the five-year medical course taking twelve years. Some never pass but still run lucrative practices. The author’s service in hospitals also added many more stories, and overwhelmed, the author could not help finally writing them. They were written in Malayalam as poems and published as ‘The Hospital Window’ (Aaspathri Jaalakam in Malayalam) later. 

The author has written three other books exploring the injustices done to poor people in hospitals, altogether five including this one. ‘Doctors Politicians Bureaucrats People And Private Practice’ explores how and why they in the rural villages and semi-towns were skillfully deprived of the services of good doctors. ‘E-Health Implications And Medical Data Theft’ examines how patients’ private medical data is stolen and sold even by governments. ‘Did A Data Mining Giant Take Over India?’ is a look into how large and wholesale the governmental medical data theft and sale in India is. Because they are already covered in these books, a few relevant topics which were otherwise appropriate for this book are excluded. My readers are requested to read those books also to get a comparatively better picture. 

The dead and the suffering in the hospitals have to have their voice because the first can never speak again and the second fear to speak. This book is dedicated to those women, old people and little angels who come to hospitals with no money in their pockets, undergo every injustice, discrimination, shame and medical crime poverty can subjugate them to in hospitals, and silently weeping say farewell to mankind and the world to go to other kindlier worlds. 

The readers may have dissenting opinions on the views expressed by the author in this book but it can’t be helped.

Written and first published on: 21 April 2020.

Tags:


English Essays Articles,

FROM THE BOOK:

https://www.amazon.com/dp/B087D34RVM

 

About the Author P. S. Remesh Chandran:

00. Author Profile Of P S Remesh Chandran By Sahyadri Archives.

Editor of Sahyadri Books & Bloom Books, Trivandrum. Author of several books in English and in Malayalam. And also author of Swan: The Intelligent Picture Book. Born and brought up in the beautiful village of Nanniyode in the Sahya Mountain Valley in Trivandrum, in Kerala. Father British Council trained English teacher and Mother University educated. Matriculation with distinction and Pre Degree Studies in Science with National Merit Scholarship. Discontinued Diploma studies in Electronics and entered politics. Unmarried and single.

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Blog: http://sahyadribooks-remesh.blogspot.com/
Site: https://sites.google.com/site/timeuponmywindowsill/
E-Mail: bloombookstvm@gmail.com

Post: P. S. Remesh Chandran, Editor, Sahyadri Books, Trivandrum, Padmalayam, Nanniyode, Pacha Post, Trivandrum- 695562, Kerala State, South India.